New client forms
Mandatory Disclosure Statement & Consent for Treatment, Financial Agreement, Allia Platform Consent, Telehealth Consent when applicable, Client Intake Form, and Release of Information when needed.
Flat Tops Counseling, LLC
Client forms and Allia Platform.
Most client forms are completed securely through the client portal after scheduling or referral review.
Contact
Brice Glasscock, CAS, NCAC I
Colorado Certified Addiction Specialist
Credential No. ACC.0021111
Phone: (970) 639-0624
Email: bricecas@flattopscounseling.com
Office: 889 Park Ave., Meeker, CO 81641
By appointment only
Client Forms & Portal
Forms are handled through the Allia Platform whenever possible.
Most client forms are completed securely through the client portal. New clients will receive the appropriate forms after scheduling or after a referral is reviewed.
Evaluation forms
Substance Use Evaluation Consent, Diagnostic Intake Assessment, Release of Information, and referral source information when a report or outside communication is requested.
Allia Platform
Allia may be used for forms, digital signatures, secure messaging, document sharing, telehealth access, and practice communication.
Protecting privacy
Please do not send urgent, emergency, or highly sensitive health information through website forms or standard email.
Portal and forms questions
For help with forms, portal access, records requests, or releases of information, contact records@flattopscounseling.com or call (970) 639-0624.